Legislature(2009 - 2010)CAPITOL 106
04/01/2009 08:00 AM House EDUCATION
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s)|| Professional Teaching Practices Commission | |
| HB197 | |
| HB204 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 197 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| += | HB 204 | TELECONFERENCED | |
HB 204-POSTSECONDARY MEDICAL EDUC. PROG. 9:34:41 AM CHAIR SEATON announced that the final order of business would be HOUSE BILL NO. 204, "An Act increasing the number of students pursuing a medical education who are provided postsecondary educational services and programs; and providing for an effective date." 9:35:22 AM REPRESENTATIVE WILSON moved to adopt CSHB 204, Version 26- LS0778\R, Mischel, 3/31/09, as the working document. CHAIR SEATON objected for discussion purposes. 9:35:51 AM SAM DIX, Staff, Representative Nancy Dahlstrom, Alaska State Legislature, explained that Version R continues to increase the number of students pursuing a medical education to 24, although the language now specifies "24" not "up to and including 24". The legislation, Version R, now includes provisions that would allow student loan forgiveness to Alaska residents who participate in the Washington, Wyoming, Alaska, Montana, Idaho Medical Education Program (WWAMI), receive a medical education degree, and provide qualified practice in the state. The loan forgiveness is detailed in Section 2 of Version R. Section 3 of Version R states that those who received a degree from the WWAMI program must be a full-time employee or practitioner for at least six months in order to qualify for the loan forgiveness. He highlighted that Section 3 specifies that "full-time employee" doesn't include seasonal or temporary employment. Section 4 defines a "qualified practice" to be a facility where medical services are provided by a physician who received medical education under the WWAMI program, where a significant percentage of the patients of the practice are uninsured or covered under Medicare or other medical assistance, and is located in a medically underserved area of the state. Section 4 also specifies the definition of "rural". Section 5 relates that Department of Health and Social Services (DHSS) may establish standards for a qualified practice in regulation, including the definition of "medically underserved area" and "significant percent" in terms of patients that would qualify a practice for loan forgiveness. Section 6 is the effective date of July 1, 2010. 9:40:37 AM REPRESENTATIVE GARDNER directed attention to Section 3, which specifies that in order to qualify for [loan] forgiveness, a person must be a full-time employee or practitioner for a period of at least six months. She asked, "Does it mean they have to be a doctor for six months before the clock starts ticking on their employment under which loans will be forgiven?" MR. DIX answered that Section 3 means that they must be considered a full-time employee within the first year after graduating from the WWAMI program. REPRESENTATIVE GARDNER surmised then an individual can't graduate from the WWAMI program, take a job elsewhere for a few years, and then return to Alaska to work and obtain loan forgiveness. MR. DIX stated his agreement. 9:42:13 AM CHAIR SEATON asked then whether a WWAMI graduate seeking loan forgiveness would have to return directly to Alaska or could they return to Alaska with an outstanding WWAMI loan. MR. DIX clarified that if a WWAMI graduate practices or takes up employment outside of the medical practice, they will be considered under the five years employment, 20 percent loan forgiveness program. 9:43:05 AM CHAIR SEATON related his understanding that Section 3 means that an individual who takes a job for one month can't receive loan forgiveness. However, the language doesn't specify that a WWAMI graduate who takes a job elsewhere and then returns to Alaska and is employed for six months can't receive loan forgiveness. He expressed the need to clarify this point. MR. DIX deferred to departmental representatives. 9:44:54 AM ALICE RARIG, Planner IV, Department of Health and Social Services, related her belief that Section 3 doesn't seem to imply that service couldn't be interrupted. Therefore, she suggested that the sponsor may need to provide clarification on this point. She opined that the clock for loan forgiveness would start once the individual begins full-time employment in a qualified practice and after six months could apply for forgiveness. 9:45:59 AM REPRESENTATIVE NANCY DAHLSTROM, Alaska State Legislature, speaking as the sponsor of HB 204, related that the intent with HB 204 is to provide more efficient and better quality medical care for all Alaskans. She said she shared Ms. Rarig's understanding that there wouldn't be a break in the service. She offered to request an opinion from Legal and Research Services. 9:47:01 AM CHAIR SEATON opined that the language seems straight forward in that this would require employment six months in order to qualify for loan forgiveness. However, Section 3 doesn't stipulate that a WWAMI graduate couldn't take a job in another state prior to working six months in Alaska and applying for loan forgiveness or return to Alaska and have a six-month delay prior to taking a job. The language simply says that a [WWAMI graduate] would have to be employed in Alaska for at least six months. 9:47:49 AM REPRESENTATIVE GARDNER said that she has received adequate clarification on the language and pointed out that the only new language in Section 3 is the addition of "or practitioner". 9:48:14 AM REPRESENTATIVE EDGMON asked if the language "or for services provided in a qualified practice in" and "or practice" on page 2, lines 13-16, is defined elsewhere or is supportive of a full- time employee. CHAIR SEATON pointed out that page 3, subsection (i) provides the definition of "qualified practice". 9:49:28 AM REPRESENTATIVE EDGMON then asked if there is a difference between a medically underserved area and a rural area. MR. DIX answered that DHSS will define those terms. MR. RARIG pointed out that the term "rural" is defined in the legislation on page 3, lines 11-13. The term "medically underserved area" is federal language with a specific meeting. However, "medically underserved area" has yet to be defined in state statute. She noted that DHSS has developed criteria for the Denali Commission funding priority systems and proposed an Alaska-based definition of medically underserved area. The aforementioned definition has been submitted to the U.S. Department of Health and Human Services. She said that DHSS has no qualms with developing a definition for the term for this program. There are non rural areas that may be defined as medically underserved. 9:52:02 AM CHAIR SEATON posed a scenario in which a portion of Anchorage has a lot of people who qualify for Medicare, but there aren't a lot of physicians who want to take Medicare patients. In such a situation, Anchorage could be defined as a medically underserved area because of the definition of "uninsured." He asked if the aforementioned would result in those in Anchorage receiving the same benefit as [those in rural Alaska], and thereby take away the incentive of the higher reimbursement rate for rural Alaska. Furthermore, does such a situation create a conundrum in which the higher reimbursement rate being given in rural Alaska to stimulate people to go to rural Alaska is given to those in an area with a significant number of Medicare patients. MS. RARIG related her understanding that the regulations for the medically underserved area would only apply to the census designated level and Anchorage would be considered as a whole. An area that would likely fall under the definition of a medically underserved area would be Ketchikan, where there is difficulty for certain portions of the population gaining access to services, although the area wouldn't qualify under the rural definition due to the population being over 7,500. Ms. Rarig said that most qualifying practices would fall under the first designation in which the practice can demonstrate that the practice serves a significant portion of individuals who receive Medicare or Medicaid, or are uninsured. 9:54:31 AM CHAIR SEATON surmised that under Section 4(i)(1)(A) Anchorage would qualify for the higher reimbursement if the [WWAMI graduate joins] a practice for which a significant portion of the patients are Medicare patients. He asked if that would be a correct assumption. MS. RARIG answered that she believes that would be a correct assumption. 9:55:33 AM CHAIR SEATON expressed concern with having a higher reimbursement rate for those living in the lowest cost of living areas in the state while possibly taking away the rural incentive. MS. RARIG stated her understanding that there are a number of practices in Anchorage and other urban areas that are taking a disproportionate number of [Medicare, Medicaid, uninsured] patients. These practices feel that they're in an unfair situation in terms of reimbursement and threaten to be overwhelmed when other practices won't accept Medicare patients. She opined that this legislation is meant to provide a recruitment incentive for those practices to be able to hire more physicians and perhaps create a more balanced competition [in the urban areas]. REPRESENTATIVE DAHLSTROM stated that the intent is not to identify any particular population in the state, but rather to provide better medical service for all Alaskans. Furthermore, many rural residents come to Anchorage for medical services. She clarified that this legislation wouldn't qualify the Anchorage area as a whole, only those practices that treat the underserved populations. 9:58:01 AM REPRESENTATIVE WILSON acknowledged the sponsor's view, and questioned whether the intent is to include Anchorage. REPRESENTATIVE DAHLSTROM responded that the intent is to include Anchorage as well as the entire state. 9:59:06 AM REPRESENTATIVE WILSON opined then that more of [the WWAMI graduates] will return to Anchorage to receive loan forgiveness. REPRESENTATIVE DAHLSTROM offered that there are those who will consciously choose to teach in rural settings. She said that she didn't believe all [WWAMI graduates] will return to Anchorage. 10:00:45 AM CHAIR SEATON directed attention to the language on page 2, line 8, which refers to "employment in the state in a medical residency program". The only medical residency program is offered in Anchorage. If there are a number of Medicare and uninsured patients served at the hospital [providing a medical residency program], would the language mean that any [WWAMI student] at such an institution would be reimbursed at the high rate, as if they were serving in rural Alaska. MR. DIX said that the medical residency program would have to be considered by DHSS as serving a significant percentage of Medicare and uninsured patients. 10:02:05 AM CHAIR SEATON expressed the need to answer the aforementioned and how it works into this legislation, although he said he wouldn't hold the legislation based on that matter. If the hospital at which a physician is serving has a high incidence of Medicare and/or uninsured patients, then this legislation seems to open the possibility of everyone in their residency program being reimbursed as if they're serving in rural Alaska. He opined that that's not the intent, and therefore he suggested that the sponsor work on that matter. 10:03:00 AM REPRESENTATIVE BUCH expressed concern with the [lack of a] definition for the terms "medically underserved area" and "significant percentage" and the lack of a fiscal note. 10:03:44 AM CHAIR SEATON stated that HB 204 would be held over. [The motion to adopt CSHB 204, Version 26-LS0778\R, Mischel, 3/31/09, was left pending per Chair Seaton's objection.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| Carol J. Schaeffer and Lou Pondolfino.pdf |
HEDC 4/1/2009 8:00:00 AM |
|
| cshb204 WORKDRAFT.pdf |
HEDC 4/1/2009 8:00:00 AM HEDC 4/3/2009 8:00:00 AM |
HB 204 |
| HB 204 information.pdf |
HEDC 3/30/2009 8:00:00 AM HEDC 4/1/2009 8:00:00 AM HEDC 4/3/2009 8:00:00 AM |
HB 204 |
| HB 197.pdf |
HEDC 4/1/2009 8:00:00 AM |
HB 197 |
| Linda Lee Gillam Black.pdf |
HEDC 4/1/2009 8:00:00 AM |